Individual provider Active NPI

Teresa Cecelia Shinedling, LMSW ACSW MFT

  • Clinical Social Worker
  • Bay City, MI
National Provider Identifier
1639134521
Registry record updated Sep 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801007932 Issued in MI
Practice address
2355 1/2 Delta Rd
Bay City, MI 48706
Phone
(989) 667-5654
Fax
(989) 667-5330
NPI assigned
Apr 20, 2006
Last updated
Sep 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801007932 MI Primary

Addresses

Primary practice location

2355 1/2 Delta Rd
Bay City, MI 48706

Mailing address

PO Box 653
Santa Clara, UT 84765-0653
Phone (435) 652-3775

Other identifiers 2

IdentifierTypeStateIssuer
046048OtherMIVALUE OPTIONS
P208904820OtherMIBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110615000390 UT Practitioner - Clinical Social Worker 6406033620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Hurricane, UT 84737
Phone (435) 703-5527

445 S Coral CV
Hurricane, UT 84737-1255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801007932MIMDClinical Social Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473379200000",
    "number": "1639134521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "SANTA CLARA",
            "state": "UT",
            "postal_code": "847650653",
            "telephone_number": "435-652-3775",
            "fax_number": "435-652-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 1/2 DELTA RD",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "48706",
            "telephone_number": "989-667-5654",
            "fax_number": "989-667-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINEDLING",
        "first_name": "TERESA",
        "middle_name": "CECELIA",
        "credential": "LMSW ACSW MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2016-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801007932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "046048",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "P208904820",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay City, MI

Sources for this page

Verify at the official NPI Registry.